CAJ | 학술논문

目的探讨Solitaire AB支架取栓术在伴有心房颤动(简称房颤)患者大脑中动脉急性闭塞中的应用,评价其效果及安全性.方法对象为2012年6月至2013年12月苏州大学附属第三医院收治的40例房颤合并大脑中动脉急性闭塞患者,采用Solitaire AB支架取栓治疗.根据术前及术后72 h美国国立卫生研究院卒中量表(NIHSS)评分、术后即刻脑梗死溶栓分级(TICI分级)、术后90 d改良的Rankin量表(mRS)评价病情和治疗效果,并将患者分为恢复良好和恢复不良两组进行影响因素差异统计学意义比较.结果依据TOAST分型心源性脑栓塞的诊断标准,40例中心源性栓塞28例.术后有效再通(TICI 2b-3级)37例(92.5％),术后90 d恢复良好(mRS≤2分)19例(47.5％),恢复不良(mRS＞2分)21例(52.5％),其中病死5例(12.5％),症状性脑出血6例(15％).无支架相关的手术并发症.恢复良好和恢复不良两组术前NIHSS评分分别为(17.0±0.4比18.6±0.4,P＜0.05),症状出现到有效血流恢复时间分别为[(312±52) min比(370±68) min,P＜0.05],差异有统计学意义.结论 Solitaire AB支架取栓术应用于房颤合并大脑中动脉急性闭塞患者是一项安全有效的治疗方法.
목적 탐토Solitaire AB지가취전술재반유심방전동(간칭방전)환자대뇌중동맥급성폐새중적응용,평개기효과급안전성.방법 대상위2012년6월지2013년12월소주대학부속제삼의원수치적40례방전합병대뇌중동맥급성폐새환자,채용Solitaire AB지가취전치료.근거술전급술후72 h미국국립위생연구원졸중량표(NIHSS)평분、술후즉각뇌경사용전분급(TICI분급)、술후90 d개량적Rankin량표(mRS)평개병정화치료효과,병장환자분위회복량호화회복불량량조진행영향인소차이통계학의의비교.결과 의거TOAST분형심원성뇌전새적진단표준,40례중심원성전새28례.술후유효재통(TICI 2b-3급)37례(92.5％),술후90 d회복량호(mRS≤2분)19례(47.5％),회복불량(mRS＞2분)21례(52.5％),기중병사5례(12.5％),증상성뇌출혈6례(15％).무지가상관적수술병발증.회복량호화회복불량량조술전NIHSS평분분별위(17.0±0.4비18.6±0.4,P＜0.05),증상출현도유효혈류회복시간분별위[(312±52) min비(370±68) min,P＜0.05],차이유통계학의의.결론 Solitaire AB지가취전술응용우방전합병대뇌중동맥급성폐새환자시일항안전유효적치료방법.
Objective To investigate the endovascular management strategy of mechanical thrombectomy using Solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation and assess the safety and efficacy.Methods From June 2012 to Dec 2013, 40 patients of acute middle cerebral artery occlusion with atrial fibrillation admitted to our institutes were treated by Solitaire AB stent.Clinical status was evaluated by the score of National Institute of Health Stroke Scale (NIHSS) before and 72 hours after treatment, immediate scale of thrombolysis in cerebral infarction (TICI) after thrombectomy, the 90 d score of Modified Rankin Scale (mRS).The patients were classified into good result group (mRS ≤ 2) and bad result group (mRS ＞ 2) according to the mRS score.Results Out of 40 cases, there were 28 cases caused by cardiogenic embolism.Recanalization was successful (TICI score 2b or 3) in 37 out of 40 (92.5％).90 d follow-up mRS was 0-2 in 19 of 40 patients (47.5％).3-5 in 21 patients (52.5％).5 patients died (12.5％).Symptomatic hemorrhagic transform developed in 6 patients (15％).No complications related to the Solitaire AB thrombectomy occurred.Mean time from symptom onset to recanalization (312 ±52 min vs 370 ±68 min, P ＜0.05) and initial NIHSS score (17.0 ±0.4 vs 18.6 ± 0.4, P ＜ 0.05) were of significant difference between good result group and bad result group.Conclusion These results confirm that mechanical thrombectomy using solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation is safe and effective.